Abstract

MENEZO VIADERO, Raquel et al. Pre-dilution versus post-dilution on-line haemodiafiltration: a comparative study of dialytic efficacy and haemodynamic tolerance. Enferm Nefrol [online]. 2012, vol.15, n.2, pp.108-113. ISSN 2255-3517.  https://dx.doi.org/10.4321/S2254-28842012000200005.

On-line haemodiafiltration is a dialysis technique which combines the advantages of high-flow haemodialysis (diffusive transport) and haemofiltration (convective transport). This technique allows different alternatives depending on how the reinfusion liquid is added: pre-dilution (before the dialyser) and post-dilution (after the dialyser), each of them having advantages and disadvantages. The object of this study was to compare different dialytic and haemodynamic parameters in the pre- and post-dilution haemodiafiltration modes. A transversal prospective study was conducted of a population in dialysis already being treated with on-line haemodiafiltration, using each of the modes (pre- and post-dilution) with them for 4 weeks. The following values were recorded: systolic and diastolic arterial pressure and cardiac frequency pre- and post-session, blood flow, venous pressure, volume of blood dialysed and replacement volume. Dialysis dosage was measured by means of ionic dialysance. 26 patients were studied: 30% women and 70% men, with an average age of 61±13 years. The average time under renal replacement treatment was 117±124.45 months, and the average time in haemodialysis was 50±54.38 months. The haemodynamic parameters showed no significant differences between the two modes studied (pre- and post-dilution). A statistically significant higher value for KT was obtained for the post-dilution haemodiafiltration technique, requiring half the replacement volume of the pre-dilution mode. Conclusions: The on-line haemodiafiltration technique is tolerated well in both infusion modes. With the same blood flow, venous pressure and volume of blood dialysed, a higher dialysis dosage was achieved using the post-dilution mode. Post-dilution haemodiafiltration appears to be a better alternative than the pre-dilution mode in terms of the parameters studied as long as the issue of vascular access is not taken into account. Better KT results were achieved with this technique, requiring half the replacement volume, with the resulting saving in ultra-pure water. Pre-dilution haemodiafiltration may be an alternative for patients where a high arterial flow cannot be achieved.

Keywords : Haemodiafiltration; Methods of reinfusion; Dialysis dose; Hamodynamic tolerance.

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